Travel season adds to worry about spread of damaging diseases

Jun. 15, 2014

Getty Images North America. Joe Raedle

Written by

Samantha Hoelscher

The Cincinnati Enquirer

The summer travel season is here, posing an opportunity to spread outbreaks of mumps and measles now hitting Ohio harder than most states.

State health officials are urging Ohioans to ensure they’re vaccinated, with more than 8,000 doses of the measles-mumps-rubella vaccine administered by county health departments this year.

In the past week, Gov. John Kasich signed an executive order allowing pharmacists to administer the MMR vaccine to adults to help provide more protection from infection. The state called the measles outbreak the largest spread of the disease in the United States since 1994.

The outbreaks come as health officials deal with what they say are unfounded but lingering questions about the safety of vaccinations. Sometimes parents have fears — rooted in the renounced work of a discredited scientist more than a decade ago — that the MMR vaccine contributes to autism.

“The most common reason parents elect not to have their child vaccinated is not having all the information,” said Dr. Robert Frenck, an infectious disease specialist at Cincinnati Children’s Hospital Medical Center.

Children aren’t the only ones who aren’t being immunized. At least 419 cases of mumps have been confirmed across Ohio this year in people ranging from four months to 80 years old.

More than 230 cases of the contagious viral illness can be traced to Ohio State University. Meanwhile, there are 29 cases in 14 other counties, with one case in Marion County.

Meanwhile, Ohio’s total in a separate measles outbreak has grown to 298 cases clustered in eight counties in Central Ohio. There have been no cases in Marion County

The disease, which is more serious than mumps, has caused eight hospitalizations.

It’s particularly hitting a group of Amish people who had traveled to the Philippines, which has had an epidemic of the respiratory illness. Nearly 190 of the measles cases are in Knox County.

18 states so far

The Ohio outbreak is one of the reasons the U.S. now has a 20-year high number of measles cases, with federal officials seeing no end in sight to the outbreak.

The measles outbreak is in 18 states, according to data from the Centers for Disease Control and Prevention.

“This is not the kind of record we want to break, but should be a wake-up call for travelers and for parents to make sure vaccination records are up to date,” said Anne Schuchat, director of the CDC’s National Center for Immunizations and Respiratory Diseases, during a telephone news conference last week.

The Ohio mumps and measles outbreaks also come at a time when the Ohio Legislature just left for summer recess without passing a bill requiring all children that attend day care centers be vaccinated. The state is the only one in the nation without such a requirement.

The bill — sponsored by Reps. Ryan Smith, R-Gallipolis, and Nickie Antonio, D-Lakewood — remains in the House Health Committee.

In Ohio, only school-age children are required to take nine out of the 17 vaccinations recommended on the CDC schedule.

Ohio ranks 34 out of 51 (including the District of Columbia) for childhood vaccinations by the age of 35 months. The immunization rate for Ohio children for all vaccines by age 35 months is at 66.8 percent; the national average is at 68.4 percent.

The rate of people refusing to get their children vaccinated for religious or other reasons varies from state to state, according to the CDC. Illinois and Alaska had the highest refusal rates in 2012-13, while Mississippi and New Mexico had the lowest. In Ohio, the refusal rate was 2 percent; the national rate was 1.8 percent.

Understanding the risk

CDC statistics show the measles, mumps and rubella vaccine has a much higher acceptance rate, with 90.8 percent of all children up to age 35 months receiving it. MMR vaccination rates in Ohio were slightly under the nation’s in 2012-13, CDC data shows.

Health officials say the MMR vaccine is useful because it will give 97 percent of people immunity to measles and 88 percent of people immunity to mumps. Receiving both doses of the vaccination, which takes effect in two to three weeks, is highly encouraged; the Ohio Department of Health considers those who have only taken a single dose to still be a high risk.

Concerns about the MMR vaccine were stoked in 1998, when British researcher Andrew Wakefield, who has since lost his right to practice medicine in the United Kingdom, released a claim that led some people to believe getting the shots could trigger autism in children.

But four major medical studies were conducted from 2002 to 2008 attempting to recreate Wakefield’s findings, and researchers found no link between the vaccine and autism. In 2010, The Lancet, which originally published Wakefield’s research, retracted his paper, and in 2011, the British Medical Journal called Wakefield’s research “an elaborate fraud.”

CDC experts say that while signs of autism often appear around the same time the vaccines are first given, the vaccine isn’t the cause.

Cincinnati Children’s Frenck, who also is a professor of pediatrics at the University of Cincinnati College of Medicine, thinks the problem with getting children vaccinated is something more basic.

“Many parents think infectious diseases are no longer present,” he said, adding that “the only disease that has been eradicated from the Earth is smallpox.”

“All the other infectious diseases are still there waiting for their opportunity to infect a susceptible host,” Frenck said. “Vaccines are the things that keep our kids safe from these infections.”

About mumps

About mumps

Mumps is a contagious viral disease that is spread via mucus or saliva when an infected person coughs, sneezes or talks.

The disease generally does not cause serious problems. In rare cases, however, mumps can cause encephalitis (swelling of the brain) or meningitis (swelling of the tissue covering the brain and spinal cord). Even rarer are problems with the reproductive system.

Mumps typically starts with a few days of fever, headache, muscle aches, tiredness and loss of appetite, and is followed by swelling of salivary glands.

There is no specific treatment for mumps other than rest. If someone becomes ill, they should seek medical attention but should call their doctor in advance so that they don’t have to sit in the waiting room for a long time and possibly infect other patients.

Other than getting the MMR vaccine, people can prevent mumps and other infections by:

• Washing their hands with soap and teaching children to wash their hands.

• Not sharing eating utensils.

• Cleaning any surfaces that are frequently touched, such as toys, doorknobs, tables and counters with soap and water or cleaning wipes.

About measles

Measles is a highly contagious respiratory disease caused by a virus.

Measles is seen so infrequently today that doctors may not always recognize symptoms, which include fever, cough, runny nose, red eyes, sore throat and a red rash that appears after three to five days.

About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. For every 1,000 children who get measles, one or two will die. Other rash-causing diseases often confused with measles include roseola and rubella (or German measles).

Symptoms usually begin more than a week after being infected. People showing symptoms are highly contagious two days before and five days after they develop symptoms.

Before the measles vaccination program began, an estimated 3 million to 4 million people in the U.S. were infected each year, of whom 400 to 500 died, 48,000 were hospitalized, and another 1,000 developed chronic disability from measles encephalitis (swelling of the brain). Widespread use of the measles vaccine has led to a greater than 99 percent reduction in measles cases in the U.S. compared with the prevaccine era.

Measles is still common in other countries. There were 164,000 measles deaths worldwide in 2008, or about 18 deaths every hour.

Health officials advise people who are showing symptoms to stay at home from work, school and public gatherings for five days after the symptoms appear. Cover your mouth and nose, wash your hands frequently with soap and water and make an appointment with your doctor to be diagnosed.

Source: Centers for Disease Control and Prevention

About the MMR vaccine

About the MMR vaccine

To get the vaccine, consult your primary care physician or county health department.

The MMR vaccine is a weakened or attenuated live virus vaccine. After it is injected into the human body, the viruses grow and cause a harmless infection in the vaccinated person with few, if any, symptoms. The person’s immune system fights the infection caused by the weakened viruses and immunity develops, which lasts throughout that person’s life.

The most common adverse events after the MMR vaccine are pain where the vaccine is given, fever, a mild rash and swollen glands in the cheeks or neck.

Studies have shown a small increased risk of convulsions or febrile seizures. Although terrifying to parents, the vast majority of these seizures, which occur eight to 14 days after vaccination, are short in duration and harmless.

Sources: Hamilton County and Northern Kentucky health departments; Centers for Disease Control and Prevention; and the National Institute of Neurological Disorders and Stroke